This is a submission for a Fogarty International Center K01 International Research Scientist Development Award for Dr. Eric D. McCollum, a pediatric pulmonologist at the Johns Hopkins Eudowood Division of Pediatric Respiratory Sciences. Dr. McCollum is a junior clinical investigator in the field of childhood respiratory illnesses in low-resource countries. This K01 award will provide Dr. McCollum with the support needed to achieve the following objectives: (1) to become an expert in clinical research implementation and management in Asian resource-limited settings; (2) to develop skills in advanced study design and biostatistical methods; and (3) formulate multidisciplinary, long-distance collaborations with pediatric pulmonologists. To accomplish these objectives, Dr. McCollum has crafted a mentoring team including a US primary mentor, Dr. Abdullah Baqui, Professor in the International Health Department of Johns Hopkins Bloomberg School of Public Health, an international leader of child health in low-resource Asian countries, and a Bangladesh primary mentor, Dr. Dipak Mitra, Assistant Scientist in the International Health Department of Johns Hopkins Bloomberg School of Public Health and a child health expert based in Bangladesh, as well as four co-mentors; Drs. Katherine O'Brien and Bareng Aletta Sanny Nonyane, experts in child respiratory epidemiology and analysis, respectively; and Drs. Pamela Zeitlin and William Checkley, both specialists in pulmonology. Pneumonia is the number one cause of childhood death globally as well as in Asia. Dr. McCollum's research will leverage the ongoing multicenter Pneumococcal Vaccine Impact study to evaluate pulse oximetry as a pneumonia diagnostic in the community care of rural Bangladeshi children (Aim 1) and to develop and validate a childhood respiratory illness severity score appropriate for community care in Asia (Aim 2). In Aim 1, Dr. McCollum will lead a team of lay community health workers (CHWs) in the enrollment of 1,500 rural Bangladeshi children sick with cough and/or difficulty breathing in order to assess whether a low oxygen saturation is associated with radiographic pneumonia. In Aim 2, Dr. McCollum will direct a team of CHWs to recruit 2,200 rural Bangladeshi children with World Health Organization-defined non-severe pneumonia in order to develop and validate a risk score predictive of oral antibiotic failure and appropriate for CHWs. The research described in this application will serve as the foundation for independent funding proposals for intervention trials using pulse oximetry in rural Asian community care programs as a diagnostic pneumonia tool and as a validated instrument to assess pneumonia severity.